For many years, doctors have known that screening for certain cancers saves lives. Breast cancer and prostate cancer are two examples. Now you can add lung cancer to that list. The National Lung Screening Trial results show screening people at high risk of lung cancer with CT scans lives. To learn more, visit http://mayocl.in/2xJdaq0
Richard Rubenstein, a retired executive from Scottsdale, Arizona, shares his experience battling rectal cancer diagnosed in 2007. He explains his medical and surgical treatment at Mayo Clinic in Arizona while giving those overcoming a cancer diagnosis hope and wisdom.
Sitting for long hours is linked to a whole lot of health problems. It’s even been referred to as “sitting disease.” There are things you can do break up the time you spend sitting. Here’s how to take a stand for your health.
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Max Harris, a twenty-nine year old patient at Mayo Clinic in Arizona, shares his experience battling a rare form of leukemia, acute myelogenous leukemia (AML). He describes undergoing a bone marrow transplant as treatment for AML. Max explains what helped him get through his treatment and how he is doing now following the bone marrow transplant.
To request an appointment, visit http://www.mayoclinic.org/departments-centers/transplant-center/sections/request-appointment/ptc-20203893?mc_id=us&utm_source=youtube&utm_medium=sm&utm_content=video&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&cauid=100504
A diagnosis of pancreatic cancer can be devastating news. It is often very aggressive and tough to treat. But research offers great hope for patients in terms of early diagnosis and better treatments. Here’s the story of one woman, a patient at Mayo Clinic, who is winning her battle with pancreatic cancer.
27, 2018, by NCI Staff
For some patients who are newly diagnosed with metastatic lung cancer, the combination of a treatment that helps the immune system to fight cancer—an immunotherapy—and chemotherapy may help them to live longer than chemotherapy alone, according to the results of a large clinical trial.
In the trial, patients with metastatic nonsquamous non-small cell lung cancer (NSCLC) who received the drug pembrolizumab (Keytruda) plus chemotherapy had improved overall survival and progression-free survival compared with patients who received chemotherapy alone.
After a median follow up of 10.5 months, patients who received pembrolizumab were 51% less likely to die than patients who received chemotherapy alone. After 12 months, an estimated 69.2% of patients in the pembrolizumab–chemotherapy combination group, but only 49.4% of those in the chemotherapy group, were still alive.
Pembrolizumab is one of a class of immunotherapy drugs known as checkpoint inhibitors.
The results, from the KEYNOTE-189 clinical trial, were presented at the annual meeting of the American Association for Cancer Research (AACR) in Chicago on April 16 and published concurrently in the New England Journal of Medicine.
Last year, the Food and Drug Administration (FDA) approved the combination of pembrolizumab and chemotherapy for some patients with NSCLC. But the treatment has not been widely adopted, in part because the trial that led to its approval was a small phase 2 study, said Roy Herbst, M.D., Ph.D., of the Yale Cancer Center.
Clinicians have been waiting for the results of the phase 3 trial, noted Dr. Herbst, who discussed the KEYNOTE-189 trial during a plenary session at the AACR meeting. “And these results have exceeded all expectations.”
He and other experts at the meeting predicted that the pembrolizumab–chemotherapy combination would now be commonly used as the initial treatment for certain patients.
“This study represents a total change in the way we approach the treatment of patients with metastatic lung cancer,” said the trial’s lead investigator, Leena Gandhi, M.D., Ph.D., of the Perlmutter Cancer Center at NYU Langone Health.
A New Treatment Option
In the clinical trial, more than 600 patients were randomly assigned to receive either a standard chemotherapy regimen alone or the chemotherapy regimen plus pembrolizumab—both as an initial treatment for 3 months and as an extended, or maintenance, treatment.
Patients were eligible for the trial if they had not been treated previously for advanced lung cancer and if their tumors lacked mutations in the ALK or EGFR genes. (Effective targeted therapies exist and are the standard of care for patients whose tumors have ALK or EGFR mutations.)
Merck, which manufactures pembrolizumab, funded the trial.
After a median follow-up of 10.5 months, the estimated median overall survival was 11.3 months in the chemotherapy-alone group but was not reached in the pembrolizumab-combination group.
Patients in the trial treated with pembrolizumab also lived longer without their disease progressing, with a median progression-free survival of 8.8 months versus 4.9 months in patients treated only with chemotherapy.
The addition of the immunotherapy drug to chemotherapy did not substantially increase side effects, Dr. Gandhi noted. However, more patients receiving pembrolizumab experienced a sudden change in kidney function, a condition known as acute kidney injury (5.2% in the pembrolizumab-combination group versus 0.5% in the chemotherapy-alone group).
Patients receiving the combination therapy—and especially patients who may be at risk for kidney problems—should be monitored closely for side effects, noted Arun Rajan, M.D., who studies lung cancer in NCI’s Center for Cancer Research and was not involved in the study.
Testing a Combination of Immunotherapy Drugs
“This is a new era for non-small cell lung cancer,” Dr. Herbst said. The new results, he went on, build on decades of advances in treating lung cancer that began with chemotherapy, continued with targeted therapies, and have led, most recently, to immunotherapies.
But, despite this progress, many patients with metastatic lung cancer who initially respond to these treatments experience a recurrence, Dr. Herbst continued. “We’re doing well, but we can do even better by personalizing therapies.”
He noted that another clinical trial presented at the meeting (and published in the New England Journal of Medicine) could help move the field in this direction by providing information about a potential biomarker of response to immunotherapy called tumor mutational burden. This measurement is an assessment of the number of genetic mutations in a tumor.
The trial, CheckMate-227, included a comparison of the combination of two checkpoint inhibitors—nivolumab (Opdivo) and ipilimumab (Yervoy)—versus chemotherapy in patients with advanced NSCLC who had not previously received chemotherapy for their disease. Lung tumors were also assessed for tumor mutational burden.
Of the 1,004 patients for whom information on tumor mutational burden was available, 444 were found to have a high mutational burden. Among this group, the estimated 1-year progression-free survival rate was 42.6% with nivolumab plus ipilimumab versus 13.2% with chemotherapy. After a minimum follow-up of 11.5 months, patients who received the immunotherapy combination were 42% less likely to have their cancer progress or to die than those in the chemotherapy group.
Among patients with a low tumor mutational burden, progression-free survival was similar between the combination-immunotherapy group and the chemotherapy group. The rates of treatment-related side effects were similar between the two groups.
Matthew Hellmann, M.D., of Memorial Sloan Kettering Cancer Center presented results from the study, which was supported by Bristol-Myers Squibb and Ono Pharmaceutical, in Chicago.
Although longer follow-up is needed to assess whether combination immunotherapy extends overall survival compared with chemotherapy, Dr. Rajan said the ipilimumab–nivolumab combination “could be a potential treatment option for patients with NSCLC who have high tumor mutational burden, lack targetable genomic changes, and wish to avoid chemotherapy altogether.”
Identifying New Molecular Subtypes of Lung Cancer
“This study builds on the progress we’ve made in precision medicine for lung cancer and validates tumor mutational burden as a biomarker,” said Dr. Hellman.
Both studies collected information on a different biomarker of potential response to checkpoint inhibitors—the levels of a protein called PD-L1 on tumor cells.
In CheckMate-227, patients with high tumor mutational burden benefited from the combination of nivolumab and ipilimumab regardless of PD-L1 level. In KEYNOTE-189, patients with high and low PD-L1 levels benefited from the pembrolizumab combination, “but there was increasing benefit with increasing levels of PD-L1,” said Dr. Gandhi.
She stressed the importance of learning more about how to “differentiate patients” and predict responses to immunotherapies. “PD-L1 could be part of that effort,” she added.
Both KEYNOTE-189 and CheckMate-227 increase “our understanding of the distinct molecular subtypes of lung cancer,” Dr. Hellmann said. “They are a huge step forward.”
To continue this progress, Dr. Herbst encouraged physicians to enroll their patients in clinical trials, including those in NCI’s National Clinical Trials Network, so that researchers can learn more about the distinct molecular subtypes of lung cancer and how to treat the disease.
This will take time, he added in an interview later. “We spent 20 years personalizing targeted therapies, and we are now moving toward personalized immunotherapies,” he said.
Cancer of the esophagus is like many other types of cancer. It’s often curable if caught early. Treatment for esophagus cancer, even in the early stage, has traditionally been surgery — removal of the entire esophagus. But now, doctors at Mayo Clinic are using minimally invasive endoscopies to treat early cancers. Patients have the procedure and go home the very same day.
Kaye M. Reid Lombardo, M.D., and David M. Nagorney, M.D., discus treatment strategies for cholangiocarcinoma. Learn more: http://mayocl.in/2zQIW5Q
Each year, the first Friday in September is designated as Wear Teal Day. On this day, organizations unite in an effort to encourage you to dress in teal and educate yourself and those around you about the symptoms and risk factors of Ovarian Cancer.
What is Ovarian Cancer?
Ovarian cancer is a disease in which, depending on the type and stage, malignant (cancerous) cells are found inside, near, or on the outer layer of the ovaries. An ovary is one of two small, almond-shaped organs located on each side of the uterus that store eggs, or germ cells, and produce female hormones estrogen and progesterone.
Cancer develops when abnormal cells in a part of the body (in this case, the ovary) begin to grow uncontrollably. This abnormal cell growth is common among all cancer types.
Normally, cells in your body divide and form new cells to replace worn out or dying cells, and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to create new abnormal cells, forming a tumor. Tumors can put pressure on other organs near the ovaries.
Cancer cells can sometimes travel to other parts of the body, where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells move into the bloodstream or lymph system of the body. Cancer cells that spread from other organ sites (such as breast or colon) to the ovary are not considered ovarian cancer. Cancer type is determined by the original site of the malignancy.
What is the general outlook for women diagnosed with ovarian cancer?
In women ages 35-74, ovarian cancer is the fifth leading cause of cancer-related deaths. An estimated one woman in 75 will develop ovarian cancer during her lifetime. The American Cancer Society estimates that there will be over 22,280 new cases of ovarian cancer diagnosed this year and that more than 14,240 women will die from ovarian cancer this year.
When one is diagnosed and treated in the earliest stages, the five-year survival rate is over 90 percent. Due to ovarian cancer’s non-specific symptoms and lack of early detection tests, about 20 percent of all cases are found early, meaning in stage I or II.
If caught in stage III or higher, the survival rate can be as low as 28 percent. Due to the nature of the disease, each woman diagnosed with ovarian cancer has a different profile and it is impossible to provide a general prognosis. With almost 80% of women diagnosed in advanced stages of ovarian cancer, when prognosis is poor, we know that more needs to be done to spread awareness of this horrible disease that will take the lives of more than 14,000 women this year.
What are the Signs & Symptoms of Ovarian Cancer?
Ovarian cancer is difficult to detect, especially in the early stages. This is partly due to the fact that the ovaries – two small, almond-shaped organs on either side of the uterus – are deep within the abdominal cavity. The following are often identified by women as some of the signs and symptoms of ovarian cancer:
- Pelvic or abdominal pain
- Trouble eating or feeling full quickly
- Feeling the need to urinate urgently or often
Other symptoms of ovarian cancer can include:
- Upset stomach or heartburn
- Back pain
- Pain during sex
- Constipation or menstrual changes
If symptoms are new and persist for more than two weeks, it is recommended that a woman see her doctor, and a gynecologic oncologist before surgery if cancer is suspected.
Persistence of Symptoms
When the symptoms are persistent, when they do not resolve with normal interventions (like diet change, exercise, laxatives, rest) it is imperative for a woman to see her doctor. Persistence of symptoms is key. Because these signs and symptoms of ovarian cancer have been described as vague or silent, only approximately 19 percent of ovarian cancer is diagnosed in the early stages. Symptoms typically occur in advanced stages when tumor growth creates pressure on the bladder and rectum, and fluid begins to form.
Surgery to remove the cancerous growth is the most common method of diagnosis and therapy for ovarian cancer. It is best performed by a qualified gynecologic oncologist.
Most women with ovarian cancer will have surgery at some point during the course of their disease, and each surgery has different goals.
Before treatment begins, it is important to understand how chemotherapy works. Chemotherapy is the treatment of cancer using chemicals designed to destroy cancer cells or stop them from growing. The goal of chemotherapy is to cure cancer, shrink tumors prior to surgery or radiation therapy, destroy cells that might have spread, or control tumor growth.
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Please note that this therapy is rarely used in the treatment of ovarian cancer in the United States. It is more often used in other parts of the body where cancer has spread.
Some women with ovarian cancer turn toward the whole body approach of complementary therapy to enhance their fight against the disease, as well as to relieve stress and lessen side effects, such as fatigue, pain, and nausea.
Complementary therapies are diverse practices and products that are used along with conventional medicine. Many women have tried and benefited from the complementary therapies listed below. Speaking with other women, in addition to the healthcare team, can suggest the therapies that may be most helpful and appropriate for each woman’s lifestyle.
Clinical trials are research studies designed to find ways to improve health and cancer care. Each study tries to answer scientific questions and to find better ways to prevent, diagnose, or treat cancer. Many women undergoing treatment for ovarian cancer choose to participate in clinical trials. Through participation in these trials, patients may receive access to new therapy options that are not available to women outside the clinical trial setting.
How am I Diagnosed with Ovarian Cancer?
Most women with ovarian cancer are diagnosed with advanced-stage disease (Stage III or IV). This is because the symptoms of ovarian cancer, particularly in its early stages, often are not acute or intense, and present vaguely. In most cases, ovarian cancer is not detected during routine pelvic exams, unless the doctor notes that the ovary is enlarged. The sooner ovarian cancer is found and treated, the better a woman’s chance for survival. It is important to know that early stage symptoms can be difficult to detect, though are not always silent. As a result, it is important that women listen to their bodies and watch for early symptoms that may present.
Did You Know?
The Pap test does not detect ovarian cancer. It aids in evaluating cells for the detection of cervical cancer.
Although there is no consistently-reliable screening test to detect ovarian cancer, the following tests are available and should be offered to women, especially those women at high risk for the disease:
- Pelvic Exam: Women age 18 and older should have a mandatory annual vaginal exam. Women age 35 and older should receive an annual rectovaginal exam (physician inserts fingers in the rectum and vagina simultaneously to feel for abnormal swelling and to detect tenderness).
- Transvaginal Sonography: This ultrasound, performed with a small instrument placed in the vagina, is appropriate, especially for women at high risk for ovarian cancer, or for those with an abnormal pelvic exam.
- CA-125 Test: This blood test determines if the level of CA-125, a protein produced by ovarian cancer cells, has increased in the blood of a woman at high risk for ovarian cancer, or a woman with an abnormal pelvic examination.
While CA-125 is an important test, it is not always a key marker for the disease. Some non-cancerous diseases of the ovaries can also increase CA-125 levels, and some ovarian cancers may not produce enough CA-125 levels to cause a positive test. For these reasons the CA-125 test is not routinely used as a screening test for those at average risk for ovarian cancer.
If any of these tests are positive, a woman should consult with a gynecologic oncologist, who may conduct a CT scan and evaluate the test results. However, the only way to more accurately confirm an ovarian cancer diagnosis is with a biopsy, a procedure in which the doctor takes a sample of the tumor and examines it under a microscope.
Research into new ovarian cancer screening tests is ongoing, and new diagnostic tests may be on the horizon. The National Ovarian Cancer Coalition monitors the latest scientific developments. Please visit their Research page for additional information.
To locate a physician in your area who can help with the symptoms you are suffering and aid in treatment, if necessary, please find one today using HealthLynked.com. We are the first of its kind social ecosystem designed to connect physicians and patients for the efficient exchange of information in a secure platform designed for communication and collaboration.
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Dr. Carola Arndt discusses osteosarcoma which is one of the most common malignant tumors of bone in teenagers and young adults. It has an incidence of 5.6 per million in children under 15 in the U.S. Dr. Arndt also discusses diagnoses, evaluation, and treatment of osteosarcoma. Treatment for osteosarcoma at Mayo Clinic is a multidisciplinary teamwork approach. Additionally, Dr. Arndt discusses Mayo Clinic’s membership in the Children’s Oncology group as well as EURAMOS (European and American Osteosarcoma Study Group).